Indications and outcomes of patients undergoing Immediate Sequential Bilateral Vitreoretinal Surgery (ISBVS): a case series.

Introduction: Bilateral vision threatening vitreoretinal disease requiring urgent surgery such as proliferative diabetic retinopathy, vitreous haemorrhage and retinal detachment are not uncommon presentations. Accepted practice has been to address each eye in separate, staged procedures. However, there are specific circumstances in which operating on both eyes in the same anaesthetic sitting may be preferable. Immediate Sequential Bilateral Vitreoretinal Surgery (ISBVS) has been rarely described in the literature. We present a series of cases and discuss the indications, risks and relative merits of this approach.

Methods: Multicentre retrospective case series of patients undergoing ISBVS. We circulated a proforma to surgeons across the United Kingdom to collate a series of cases of this rarely performed approach to collate indications, operative approach and post-operative results.

Results: Seventeen patients (34 eyes) underwent ISBVS from 8 centres. Twenty eyes had rhematogenous retinal detachments, 12 eye had diabetic vitreous haemorrhage or tractional detachment and 2 had full thickness macular hole. Principal pathology was the same bilaterally in each case. Indications for bilateral surgery included bilateral disease requiring urgent surgical intervention, high risk general anaesthetic, anticipated difficulty with follow-up, convenience in post operative care and patient preference. Visual acuity improved in 22 eyes and worsened in 2. Post operative complications included four eyes with elevated intraocular pressure, three vitreous haemorrhages, one cystoid macular oedema and one with a macular fold. One required re-operation for non-clearing vitreous haemorrhage.

Conclusions: ISBVS is a useful approach which may be underutilised, but further studies are required to validate its safety.